Archive for July, 2009

Tanning Beds Can Cause Cancer: Notes from a San Francisco Bay Area Dermatologist

Wednesday, July 29th, 2009

As summarized in Dermatology Daily for the American Academy of Dermatology, The CBS Evening News (7/28, story 8, 2:15, Couric) reported that, according to a paper published online July 29 in The Lancet Oncology, tanning beds may “pose as big a risk as tobacco and asbestos.” Medical correspondent Jon LaPook, MD, explained that the “international panel of cancer experts upgraded the warning on tanning beds from probably to definitely able to cause cancer.”

The AP (7/29, Cheng) points out that “a new analysis of about 20 studies concludes the risk of skin cancer jumps by 75 percent when people start using tanning beds before age 30.” In addition, researchers from the International Agency for Research on Cancer (IARC), the “cancer arm” of the World Health Organization, “found that all types of ultraviolet radiation caused worrying mutations in mice, proof the radiation is carcinogenic. Previously, only one type of ultraviolet radiation was thought to be lethal.” Now, “the new classification means tanning beds and other sources of ultraviolet radiation are definite causes of cancer, alongside tobacco, the hepatitis B virus, and chimney sweeping, among others.”

AFP (7/29, Hood) quotes study leader Vincent Cogliano, PhD, as saying that sunbed use causes “melanoma of the skin and…of the eye.” Cogliano also said “it is not the IARC’s role to issue recommendations, but that he hoped the new evaluation would focus attention on the issue.” Internationally, “physicians hailed the decision, and called for tighter regulations for the multi-billion dollar tanning industry.” Nina Goad, spokesperson for the British Association of Dermatologists, stated, “It is high time that steps were taken to regulate the industry, to prevent children using sunbeds.” Meanwhile, George Reuter, of France’s National Union of Dermatology, said, “We have been trying for a long time to call the attention of the government to the potential risks.”

BBC News (7/29) reports that the UK’s Sunbed Association “supports a ban on” tanning bed use for those under 16 years of age, but “argues there is no scientific evidence for a ban on young people aged 17 or 18.” Chief executive Kathy Banks said, “Research has shown that over 80 percent of sunbed users are very knowledgeable about the risks associated with over-exposure to ultraviolet [light], and the majority of sunbed users take 20 or less sunbed sessions a year.” But, Jessica Harris, Cancer Research UK’s health information officer, called for UK “ministers to implement a ban on under-18s using sunbeds immediately, and to close salons that are not supervised by trained staff.”

CBC News (7/29) explains that up “until now, only UVB radiation from solar rays was known to cause a genetic mutation,” but the IARC team “found the same mutation in the skin of mice treated with UVA.” Therefore, “the agency decided to reclassify all types of ultraviolet radiation — UVA, UVB, and UVC — as carcinogenic to humans, or Group 1 carcinogens. Previously, the three UV types were grouped as probable carcinogens.” CBC points out that the “WHO has warned people younger than 18 to avoid tanning beds. The Canadian Cancer Society has called for minors to be barred from using tanning beds, and the American Cancer Society advises people to try bronzing creams instead of tanning beds.”

The UK’s Press Association (7/29) notes that “several case-control studies provide consistent evidence of a positive association between the use of ultraviolet-emitting tanning devices and ocular melanoma.”

The UK’s Daily Telegraph (7/29) reports that the IARC study “follows research earlier this year that found the deadliest form of skin cancer, malignant melanoma, has become the most commonly diagnosed cancer among British women in their 20s.” According to “the latest available” Cancer Research UK figures, “338 women aged between 20 and 29 were diagnosed with melanoma, compared with 298 for cervical cancer.” In fact, “cases of melanoma have increased by a third since 2003, when there were 220 cases.” Overall, skin cancer cases in the UK “have more than doubled in the last decade.”

According to HealthDay (7/28, Reinberg), the Food and Drug Administration “is considering strengthening its warnings about the risk of skin cancer and eye damage” related to tanning bed use, the agency said. Meanwhile, Jeffrey C. Salomon, MD, “an assistant clinical professor of plastic surgery at Yale University School of Medicine,” who was not involved in the study, said that “the time has come for the FDA to restrict the use of tanning beds and to issue stronger warnings of their dangers.”

New York’s Newsday (7/29, Altherr), the Minneapolis Star Tribune (7/29), WLS-TV Chicago (7/28), the UK’s Sun (7/29), and WebMD (7/28, Boyles) also covered the story.

Spotlight on Acne: Notes from a San Francisco Bay Area Dermatologist

Monday, July 27th, 2009

On its website and on the air, CBS News (7/23) discussed adult acne. In a segment on The Early Show, dermatologist Jeannette Graf, MD, “spoke to Maggie Rodriguez about various solutions for chronic adult acne.” According to the American Academy of Dermatology, “acne is a disease that can affect anyone beyond puberty, and it’s the most prevalent skin condition in the United States…with almost 50 percent of adults suffering from some form of” the condition. Dr. Graf explained what triggers adult acne (genetics and hormones), “who generally suffers from it” (most often women), and “the latest treatments.” If self-treatment at home with cleansers containing salicylic acid or 2.5 percent benzoyl peroxide are not effective, Dr. Graf recommended that people with adult acne see a dermatologist “who may prescribe” retinoids, “antibiotics, or special topical creams.”

We see patients of all ages who are frustrated and embarassed by their acne. Acne can be a difficult condition to improve, which is why our office offers so many options to help patients. Our treatments include chemical peels and Silkpeel Dermalfusion to exfoliate skin and clean out pores. We also have Isolaz, which uses a vacuum suction to clean out pores followed by a light treatment to destroy acne causing bacteriea. The Levulan Photodynamic Therapy treatment for acne involves the application of Levulan, a photosensitizing agent, which is then activated with laser. Levulan PDT inactivates the bacteria that trigger acne, exfoliates the skin to unclog pores, and reduces the activity of sebaceous (oil producing) glands in the skin.

Getting acne under control may also include hormonal manipulation with birth control pills or spironolactone, antibiotics or Accutane for refractory cases. Topical treatments include Retin-A, a chemical that promotes skin exfoliation to reduce clogged pores. Benzoyl Peroxide to reduce sebum (oil) on the skin. Salicylic acid helps slow down shedding of the cells inside follicles, preventing clogging. It also helps break down blackheads and whiteheads. Topical antibiotics work by killing bacteria. This not only helps reduce the small infections in the pores, but also indirectly keeps the pores open.

One of the most gratifying parts of my job is to treat patients with acne and get results. Nothing is more rewarding than to see the positive transformation in attitude and self-confidence of patients who suffer from this condition. No longer do patients feel hopeless or depressed because of their skin. If you have always thought you had to just put up with your acne, consult with a dermatologist - start looking and feeling your best today!

Hair Growth in all the Wrong Places - Notes from a San Francisco Bay Area Dermatologist

Tuesday, July 21st, 2009

We all have heard about the “bearded lady” on display at carnival shows, but have you ever wondered about the medical cause for this condition? Or perhaps you yourself struggle with hair growth in unwanted places?

Well let’s shed some light on what can often be an embarrassing and under discussed topic. This condition that affects many women and is known as hirsutism. Hirsutism is defined as coarse pigmented hair appearing in regions of the female body where hair is not commonly found – primarily the face (upper lip, chin, and cheeks), neck, mid-chest, and low back.

Hirsutism is typically caused by excessive action of the male sex hormones (androgens) secreted by the ovaries and adrenal glands. This can occur for a variety of reasons, with the most common cause being polycystic ovarian syndrome (PCOS). Abnormally high androgen levels can also occur in women suffering from underlying adrenal and other central endocrine abnormalities. Occasionally (less than 20% of the time), hirsutism occurs in the absence of excessive androgen levels and other underlying pathology, and may be attributed to an abnormal relationship between circulating androgen and the androgen receptor sites in the hair follicles.

Why do conditions, such as Polycystic Ovarian Syndrome, stimulate excess hair growth? When more androgens (male sex hormones) are secreted by both the ovaries and the adrenal glands, it leads to an increase in their circulation and availability in the body. The androgen receptor sites that lie within the hair follicle also have an increased affinity to these circulating androgens. In other words, they are have a stronger attraction to these circulating hormones and cause a greater number of hormones to bind to available receptor sites. When androgens attach to the androgen receptor sites in the hair follicles, they cause an increase hair diameter, growth rate, length, and pigmentation.

Hirsutism affects 5-10% of women that are of reproductive age and even a greater percentage of women that are of Mediterranean and African descent. We see many women in our office for hair removal (commonly facial hair, central chest, and lower back) with hirsutism. If a woman has hirsutism, we are sure to inform them that they will not get the 80% reduction most women receive after 4-6 hair laser removal treatments because of the constant supply of hormones (androgens).

The best way to treat this condition is often with a combination of medical therapy (typically, birth control pills and/or a medication called Spironolactone) in conjunction with the removal of the unwanted hair. The goal of using medications to help manage hirsutism is intended to correct any underlying abnormal hormonal imbalances in an effort to help reduce excessive hair growth. Medications can suppress the secretion of androgens from the ovaries and adrenal glands (the 2 main sites of androgen origin), bind to circulating androgens making them unavailable to attach to the receptor sites within the hair follicles, reduce the conversion of weak androgens into stronger androgens and block androgen receptor sites within the hair follicle so available circulating androgens have no where to land.

A topical medication that can also be helpful is Vaniqua (eflornithine hydrochloride) Topical Cream. This a topical medication indicated for the reduction of unwanted facial hair in women. It slows the rate of hair growth by interfering with an enzyme that is necessary for hair growth. It should be applied twice a day and used in conjunction with laser hair removal.

If you are a female and have struggled with hair growth in not so feminine places, contact a dermatologist. He or she can help determine if hirsutism is playing a role by ordering a few simple lab tests. There is hope for controlling this condition!

Introducing Silkpeel! Notes from a San Francisco Bay Area Dermatologist

Sunday, July 12th, 2009

We are so pleased to now offer the SilkPeel™ Dermalinfusion™ system at our office!

If you are looking for a skin treatment that delivers immediate results, won’t take hours out of your busy schedule, and will leave you with noticeably better skin in under 30 minutes, then SilkPeel™ Dermalinfusion™ is the best procedure offered today.

Similar to microdermabrasion, The SilkPeel™ Dermalinfusion™ System combines non-invasive exfoliation with deep delivery of patient-specific solutions directly to the skin. We offer infusions for skin brightening, hyperpigmentation and acne. The solution doesn’t just sit on top of your skin like a lotion or cream would, instead the patented SilkPeel™ handpiece deeply delivers the vitamins, antioxidants and other therapeutic ingredients that your skin needs most. The proprietary formulations absorb down to where they will be most effective in brightening, clarifying, and hydrating your skin. Dermalinfusion™ optimizes the benefits of exfoliation and the effects of the serums without the often uncomfortable and painful effects that people experience with most peels. This system does not use crystal or other chemical exfoliants.

SilkPeel™ is exclusively offered through facilities with medical directors on staff, and isn’t available at a typical day spa or salon. The procedure is non-invasive and even soothing; delivering the results you want without harsh chemicals or uncomfortable treatments!

When you get a SilkPeel™, you won’t have any downtime, and don’t have to worry about dealing with irritated or inflamed skin. Within about 30 minutes, SilkPeel’s wet exfoliation leaves your skin silky smooth, hydrated, bright, and full of the youthful, healthy glow that we all desire.

Call our office to book an appointment and get your skin looking its best today!

Patient Education Day and Sale on Latisse & Vivite Products: Notes from a San Francisco Bay Area Dermatologist

Wednesday, July 8th, 2009

Please stop by our office for a sale and special patient education event from 9am to 4pm on Friday, July 10th!

Representatives from Allergan (the makers of Botox Cosmetic and Juvederm) will be at our office to answer questions and discuss their products. We will be offereing promotional pricing for Latisse, the first and only FDA approved product to grow your own eyelashes longer, thicker and darker. Our in office sale will also extend to the Vivite skin care line, Clinique Medical Lip Balm and the new collagen building lip treatment.

Appetizers and refreshments will be served throughout the day, so please join us for this great event!

Don’t Let the Bed Bugs Bite! Notes from a San Francisco Bay Area Dermatologist

Monday, July 6th, 2009

Just the thought of bed bugs feasting away on our skin while we sleep is enough to make your skin crawl. So how do these little creatures make their way into our homes?

Bed bugs can find their way into even the cleanest of homes through old and antique furniture, cracks and crevices in floors and walls or pets. Another common way is by returning with you from your travels.

If you have travel plans this summer, keep in mind that bed bugs thrive in tropical climates, although they can exist in any climate. They are more likely to occur in apartments or hotels where there is high turnover versus single-family homes. They like to live in old or antique furniture, mattresses and wallpaper, so be sure to check the seams and folds of your mattress, sheets and bed frame for the insects before climbing in for a good night’s rest.

Bed bugs are small, usually 0.2 inches, and reddish-brown in color. If the insects themselves cannot be seen, check for evidence of their existence, such as tiny specks of blood or excrement on sheets and mattresses. There may also be a pungent or sweet odor where there is an infestation. When returning home from travel, be sure to check all your luggage and clothing to make sure you don’t have any stow-aways.

Bed bugs are nocturnal and are ususally most active right before dawn. Although the bites are painless and affect only the surface of the skin, they will leave small red itchy bumps. Try not to scratch as this can lead to infection. In most cases, self-treatment with cortisone creams will stop the itch and heal the bite. However, some may experience a more complicated reaction such as hives, blisters or an allergic reaction. It is important to seek treatment from a doctor to determine that they are in fact bed bug bites and for steps on how to eliminate the infestation. This may include use of an insecticide, daily vacuuming and freezing of the vacuum bag for 24 hours, freezing of all bed clothes, sheets, etc. for 24 hours or washing everything in water 97 degrees Farenheit or hotter, and finally a professional inspection.

Can We Freeze Fat? - Notes from a San Francisco Bay Area Dermatologist

Friday, July 3rd, 2009

If you have ever seen a dermatologist for a wart or for precancerous lesions, your treatment may have included a spray of liquid nitrogen that “freezes” the skin. This method is known as cryosurgery, which cools skin tissue to an extreme temperature, destroying cells.

There is now preliminary evidence that this same concept may be applied to underlying adipose or fatty tissue, which would compete with fat removal techniques like liposuction. As reported in Dermatology Times, the group at Harvard Medical School in Boston published a paper on a method to remove excess fat called selective cryolysis. Through intact skin of pigs, they used a cold element at varying degrees to affect the underlying fatty tissue. Assessments performed immediately afterward and at increments up to three months, showed an obvious loss of subcutaneous fat. Inflammation was reported for up to four weeks after the treatment, but no signs of injury to the overlying skin, pigment changes, scarring or textural changes were noted.

While this study has yet to be applied to humans, it does introduce a unique concept for safe fat dissolution. I look forward to further research and results as this method continues to be explored.

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